Breast Cancer Survival in Ontario and California, 1998–2006: Socioeconomic Inequity Remains Much Greater in the United States

Abstract

This study re-examined the differential effect of socioeconomic status on the survival of women with breast cancer in Canada and the United States. Ontario and California cancer registries provided 1,913 cases from urban and rural places. Stage-adjusted cohorts (1998Stage-adjusted cohorts ( -2000 were followed until 2006. Socioeconomic data were taken from population censuses. SES-survival associations were observed in California, but not in Ontario, and Canadian survival advantages in low-income areas were replicated. A better controlled and updated comparison reaffirmed the equity advantage of Canadian health care.

How many deaths would be avoidable if socioeconomic inequalities in cancer survival in England were eliminated? A national population-based study, 1996–2006

“…In a series of studies examining the effect of socioeconomic status on cancer survival in Canada and the United States, two countries with higher survival than England, a significant advantage was found for deprived patients in Canada compared to deprived patients in the US, 12 even after adjusting for differences in stage at diagnosis. 13 These findings implicate systematic differences in access to health care between the two countries, in particular in health insurance coverage for the most deprived populations. It is also worthy of note that differences in cancer survival between black and white populations in the US 14 are wider than any difference in survival between socioeconomic 1,2 or ethnic 15 groups in England.…”

Are different groups of cancer patients offered rehabilitation to the same extent? A report from the population-based study “The Cancer Patient’s World”

“…In Denmark, the publicly paid health care system is supposed to ensure equal access to health care services regardless of socioeconomic status or employment. However, social inequality in survival after cancer has been shown in several countries [24][25][26][27], including Denmark [28,29].…”

Breast cancer care in the Canada and the United States: Ecological comparisons of extremely impoverished and affluent urban neighborhoods

“…Admittedly, our findings are most generalizable to such places. It should be noted, however, that after accounting for demographic, socioeconomic and clinical factors, place, per se, did not seem to matter in any of this study's analytic models nor in those of other of this field's studies (e.g., Gorey, in press;Gorey et al, 2009cGorey et al, , 2009d. Furthermore, though not as well controlled, this study's general pattern of findings had previously been observed in Manitoba and in a number of other states: Michigan, Washington, Connecticut, Iowa and Hawaii (Gorey et al, 1997(Gorey et al, , 2000a(Gorey et al, , 2000b(Gorey et al, , 2003.…”

“…Samples of 50 each, in extremely poor and extremely affluent, Canadian and American neighborhoods were thus required (α=0.05 [2-tailed] and power [1−β]=0.80; Fleiss, 1981). Finally, because previous research observed similar income-breast cancer care gradients in large and small urban areas, they were represented equally (Gorey et al, 2009c(Gorey et al, , 2009d). …”

“…First, though the US and Canada, respectively, rank number one and two at the top of the world's breast cancer survival distribution, the overall difference between them is miniscule (RR=1.02; Coleman et al, 2008). Second, Canada-US comparative studies of breast cancer survival that accounted for socioeconomic factors consistently observed income by country interactions (Gorey, in press;Gorey et al, 1997Gorey et al, , 2000aGorey et al, , 2000bGorey et al, , 2003bGorey et al, , 2009cZhang-Salomons et al, 2006). Moderate to strong inverse income-survival associations were consistently observed among US cohorts, but not among Canadian cohorts.…”